Criteria for return to running after ACL reconstruction
Return to running (RTR) is considered to be an important point in rehabilitation post ACL reconstruction, as it marks the transition from 'impairment-focused' to 'functional' or 'activity-specific' rehabilitation.
Conventionally, clinical decision making for RTR has been time-based (i.e., 8-16 weeks post-operatively). In more recent times, there have been increased sightings of assessment-based progression of rehabilitation.
The purpose of this review was to look for the criteria used to progress to RTR after ACL reconstruction and to identify any changes in trend of the criteria over time.
The review included studies that examined subjects who underwent ACL reconstruction without major concomitant procedures such as articular cartilage or other ligament repairs.
The review noted all outcomes or descriptions of the RTR criteria which are grouped as follows:
- Impairment Assessments
- Strength Assessments (isometric or isokinetic)
- Performance-based assessments.
The results showed that 99% of the included studies reported time-based criteria for RTR post ACL reconstruction. About 10% of studies reported using impairment-based assessments such as ROM, effusion and pain. 15% of the included studies reported using strength assessment, mostly by using isometric quadriceps limb symmetry index. Only 6% reported using performance-based criteria such as balance, gait pattern or functional tests (such as hop tests).
Concluding, the most frequently and widely used criteria for RTR post ACL reconstruction are time-based, which is most commonly at the 12 weeks post-operatively. Other common time-frames were at 8 weeks and 16 weeks. Less than 25% of all studies reported clinical, strength or performance-based criteria for RTR.
> From: Rambaud et al., Br J Sports Med 52 (2018) 1437-1444. All rights reserved to The Author(s). Click here for the online summary.